Remote Ischemic Conditioning and Stroke Recovery

This looks like a protocol. How long before your hospital implements this? Longer than 2 weeks and the board of directors needs to be fired.

Do you prefer your  incompetence NOT KNOWING? OR NOT DOING?

Remote Ischemic Conditioning and Stroke Recovery

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Matthew W. McDonald, PhD, Angela Dykes, MSc, Matthew S. Jeffers, MSc,

First Published May 6, 2021 Research Article Find in PubMed 

https://doi.org/10.1177/15459683211011224

Article information

Abstract

Remote ischemic conditioning (RIC) is a noninvasive procedure whereby several periods of ischemia are induced in a limb. Although there is growing interest in using RIC to improve stroke recovery, preclinical RIC research has focused exclusively on neuroprotection, using male animals and the intraluminal suture stroke model, and delivered RIC at times not relevant to either brain repair or behavioral recovery. In alignment with the Stroke Recovery and Rehabilitation Roundtable, we address these shortcomings. First, a standardized session (5-minute inflation/deflation, 4 repetitions) of RIC was delivered using a cuff on the contralesional hindlimb in both male and female Sprague-Dawley rats. Using the endothelin-1 stroke model, RIC was delivered once either prestroke (18 hours before, pre-RIC) or poststroke (4 hours after, post-RIC), and infarct volume was assessed at 24 hours poststroke using magnetic resonance imaging. RIC was delivered at these times to mimic the day before a surgery where clots are possible or as a treatment similar to tissue plasminogen activator, respectively. Pre-RIC reduced infarct volume by 41% compared with 29% with post-RIC. RIC was neuroprotective in both sexes, but males had a 46% reduction of infarct volume compared with 23% in females. After confirming the acute efficacy of RIC, we applied it chronically for 4 weeks, beginning 5 days poststroke. This delayed RIC failed to enhance poststroke behavioral recovery. Based on these findings, the most promising application of RIC is during the hyperacute and early acute phases of stroke, a time when other interventions such as exercise may be contraindicated.

Keywords cell death, brain repair, neuroprotection

Introduction

There is growing interest in the application of remote ischemic conditioning (RIC) to promote recovery following stroke.¹ However, preclinical evidence for RIC as a therapeutic is primarily restricted to the hyperacute poststroke phase,² a time frame of ongoing cell death versus the later phase of neural repair and behavioral recovery.³ The Stroke Recovery and Rehabilitation Roundtable (SRRR) consortium has emphasized that promising stroke recovery interventions should go through rigorous preclinical evaluation prior to clinical translation, such as replication in both sexes and across different stroke models.⁴ To date, most RIC studies have not followed preclinical recommendations of the Stroke Treatment Academic Industry Roundtable (STAIR), such as not directly assessing efficacy between sexes and relying almost exclusively on the intraluminal suture, middle cerebral artery occlusion (MCAO) model,² which has some limitations with respect to human stroke.⁴ In addition, most studies have delivered RIC at the time of reperfusion, a time frame that encompasses only a portion of the clinical population.² Early delivery of RIC makes it impossible to distinguish between neuroprotective and neurorestorative effects. This study directly addressed these RIC knowledge gaps by delivering RIC at a variety of times relative to stroke in order to capture the heterogeneity of human stroke presentation. This included delaying delivery of RIC in order to dissociate neuroprotective and neurorestorative effects, performing the first direct comparison of RIC efficacy between sexes, and using an endothelin-1 (ET-1) reperfusion model to confirm efficacy across stroke models.

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